CMS Seeks More Control Over Medicare Advantage Plans

The Centers for Medicare and Medicaid Services (CMS) is seeking public comment before it submits a proposal for more review power over Medicare Advantage plans in order “to provide adequate access to covered services to meet the needs of the population served.” The CMS says it will submit the broader review plan to the Office […]

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Private Insurers Pay Twice (or More) for Physician, Hospital Services than Medicare

At the same time that it issued its assessment of the Senate’s new health care plan, the Congressional Budget Office (CBO) released a related report comparing physician and hospital costs when paid by private insurers and when paid by Medicare and Medicare Advantage. The CBO found the average commercial payment rate for hospital admission was […]

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Hospital Quality Rating System Delayed by CMS

Is that hospital where you just had open-heart surgery a five star or a one star? You’ll have to wait until July, at the earliest, to find out. The Centers for Medicare and Medicaid Services (CMS) yesterday delayed implementation of its hospital quality rating system that was set to debut this week amid questions about […]

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CMS Seeks to Cut Medicare Drug Payments

The Centers for Medicare & Medicaid Services (CMS) has announced a proposed rule to test new models to improve how Medicare Part B pays for prescription drugs and supports physicians and other clinicians in delivering higher quality care. CMS values public input and comments as part of the rulemaking process, and looks forward to continuing […]

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Study Touts Success of Obamacare

Using results from the 2012-2015 Gallup-Healthways Well-Being Index (a daily national telephone survey of 507,055 adults aged 18-64), Journal of the American Medical Association (JAMA) analysts reported today that Obamacare has decreased the medically uninsured by 7.9 percent and  achieved significant improvement in access to health care and medications. The study, “Changes in Self-reported Insurance Coverage, […]

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Medicare Fraud Sweep Bags 243 on Charges of $712 Million in False Billing

A nationwide sweep led by the Medicare Fraud Strike Force in 17 districts has resulted in charges against 243 individuals, including 46 doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $712 million in false billings. In addition, the Centers for Medicare & Medicaid Services (CMS) also […]

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HHS to Shift Medicare Payment Basis

In a meeting with nearly two dozen leaders representing consumers, insurers, providers, and business leaders, Health and Human Services Secretary Sylvia M. Burwell yesterday announced measurable goals and a timeline to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity of care […]

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CMS Proposes to Afford Same-Sex Spouses Equal Rights

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule to fold the United States v. Windsor decision on marriage into the two medical programs it oversees by allowing same-sex spouses to participate in and administer “patient rights and services.” “Specifically, we propose to revise certain definitions and patient’s rights provisions, in […]

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CBO Estimates $104 Billion Savings in Obamacare Over Original Estimates

The Congressional Budget Office (CBO) has issued new estimates of the costs and coverage of the Affordable Care Act (ACA), finding savings of $104 billion through 2024 and $4 billion in 2014 alone. The cost for the first decade of Obamacare has been revised downward to $1.383 trillion. The savings, according to the CBO, came […]

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Obamacare Small Health Plan Caps Scrapped

As it was originally signed into law, the Affordable Care Act (ACA) capped deductibles on health plans offered in the small group market at $2,000 for individuals and $4,000 for families. Problem was, with the caps so "low," insurers threatened to raise rates sky high, so the Department of Health and Human Services (HHS) issued […]

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